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Research Article

The Reversal of Fortunes: Trends in County Mortality and Cross-County Mortality Disparities in the United States

  • Majid Ezzati mail,

    To whom correspondence should be addressed. E-mail: majid_ezzati@harvard.edu

    Affiliations: Harvard School of Public Health, Boston, Massachusetts, United States of America, Initiative for Global Health, Harvard University, Cambridge, Massachusetts, United States of America

    X
  • Ari B Friedman,

    Affiliation: Initiative for Global Health, Harvard University, Cambridge, Massachusetts, United States of America

    X
  • Sandeep C Kulkarni,

    Affiliations: Initiative for Global Health, Harvard University, Cambridge, Massachusetts, United States of America, University of California, San Francisco, California, United States of America

    X
  • Christopher J. L Murray

    Affiliations: Harvard School of Public Health, Boston, Massachusetts, United States of America, Initiative for Global Health, Harvard University, Cambridge, Massachusetts, United States of America, Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America

    X
  • Published: April 22, 2008
  • DOI: 10.1371/journal.pmed.0050066

Reader Comments (9)

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Valley of Death

Posted by plosmedicine on 31 Mar 2009 at 00:25 GMT

Author: Kenneth Thompson
Position: Associate Professor of Psychiatry and Public Health
Institution: University of Pittsburgh
E-mail: visiblehands@mac.com
Submitted Date: April 27, 2008
Published Date: April 29, 2008
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

Its an interesting phenomena that an article about the geography of mortality pays no attention to what that geography might mean. But its not surprising, given that the perspective from which the article is written, that our health care system is failing (in some places?), is really a non-geographic, non-social argument.
The question that might be asked, but apparently wasn't, is "why is there a geography to mortality? and why this geography?". The authors note that the rates of stagnant and worsening mortality follow the drainages of Ohio and Mississippi River Valley. There is a suggestion that health care in these regions must be at fault. Nothing is said- not even in the form of speculation- about the dramatic socioeconomic disruptions that have occurred in industry and agriculture in these regions. The last thirty years have seen the economic collapse of industries that once offered mass employment along the rivers and their tributaries. Meanwhile, the small family farm has also seen its demise.
The absence of any significant social safety net has certainly contributed to the casualties generated by these dramatic, heart breaking, community busting events. Yet their impact on health is hardly ever charted- and when it is, the contribution to illness and death made by our stubborn adherence to the vagaries of the invisible hand of the market and our apparent desire not to do much to help our country people is rarely acknowledged. I am willing to wager this is much more then about improving access to care and changing the quality of care provided- its about how we organize ourselves as a society.

Another piece of research, then- lets look at unemployment rates, job loss, plant closures, and farm sales by county over the last 30 years and plot them against the mortality data...

No competing interests declared.